The Need for Purposeful Teaching, Learning and Assessment of Crisis Resource Management Principles and Practices in the Undergraduate Pre-Hospital Emergency Care Curriculum: A Narrative Literature Review

Abstract

IntroductionTraditionally, undergraduate emergency medical care (EMC) training programs have, over the years, typically focussed on developing individuals with proficiency in clinical skills who can perform complex procedures in the act of administering safe and effective emergency care in the pre-hospital setting. A shortcoming of this training relates to the attention given to the soft skills needed to work efficiently in a team-based environment. Crisis resource management (CRM) is a structured, evidence-based approach to training that is designed to enhance teamwork performance in critical circumstances where the absence of coordinated teamwork could lead to undesired outcomes. MethodsA narrative review of GOOGLE SCHOLAR, MEDLINE, PUBMED, CINAHL as well as paramedic-specific journals was conducted. Articles were included if they examined the importance of CRM in pre-hospital emergency care; training undergraduate pre-hospital emergency care students on the principles and practices of CRM; and non-technical skills in pre-hospital emergency care. DiscussionResearchers found limited articles related to CRM and the pre-hospital emergency care setting. Our findings reveal that CRM focusses on addressing non-technical skills necessary for effective teamwork and that those identified to be relevant for effective teamwork in pre-hospital emergency care setting include situation awareness, decision-making, verbal communication, teamwork as well as leadership and followership skills. ConclusionEffective team management is a core element of expert practice in emergency medicine. When practised in conjunction with medical and technical expertise, CRM can reduce the incidence of clinical error and contribute to effective teamwork and the smooth running of a pre-hospital emergency care plan.

An Evaluation of Pre-Hospital Emergency Care Personnel Knowledge About Crisis Resource Management and Perspectives of Educators About Inclusion of Crisis Resource Management in the Pre-Hospital Emergency Care Curriculum

“… 40 , 41 These findings suggest that, while some PECP can attain and maintain patient and crew safety consequent of their knowledge of CRM, others may have poor compliance to patient safety due to their lack of familiarity with and poor knowledge of the principles and practice of CRM. This conclusion highlights the need for purposeful teaching, learning and assessment of CRM principles and practices in the undergraduate pre-hospital emergency care curriculum, as proposed by Rowland et al 13 However, it is worth noting that improving patient safety in the pre-hospital setting requires a multifaceted approach. Training must be accompanied by improvements to clinical systems, and maintenance of a true culture of safety in the workplace.…”

“… 12 It has been suggested that CRM can reduce the incidence of clinical error and contribute to effective teamwork and the success of a pre-hospital emergency care plan when applied in combination with good clinical practice. 13 Rall et al report that an emergency care practitioner’s knowledge of and adherence to the principles of CRM can enhance patient safety during pre-hospital care. 4 Despite these benefits, very few undergraduate pre-hospital EMC training programs purposefully teach and assess CRM principles and skills in their curricula.…”

“…Rowland et al advocated for the purposeful teaching, learning and assessment of CRM principles and practices in all pre-hospital emergency care curricula. 13 …”

Human errors and factors that influence patient safety in the pre-hospital emergency care setting: Perspectives of South African emergency care practitioners

“…To this end, ECPs who participated in this study recognised ‘poor leadership and management practices’ as factors that could contribute to errors during pre-hospital emergency care. The hierarchical parameters entrenched by the level of qualification and training in the pre-hospital environment ensures that the followership role is often assigned to lower-level cadres, while practitioners with higher qualifications assume leadership roles (Rowland, Adefuye & Vincent-Lambert 2021 ). This practice can lead to intimidation by and unsolicited pressure from colleagues, which can be a source of errors during pre-hospital emergency care, as indicated by the participants of this study.…”

“…Similarly, participants of our study reported that ‘ineffective teamwork’ could influence patient safety in the pre-hospital emergency care setting. It is recommended that deliberate teaching and training on principles and practice of crisis resource management is undertaken to enhance teamwork skills of health care practitioners (Rowland et al 2021 ).…”